Download MBBS Orthopaedics PPT 3 Prosthesis After Amputations Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Orthopaedics PPT 3 Prosthesis After Amputations Lecture Notes


Prosthesis after Amputations

Learning objectives

? Post operative and preprosthetic care
? Overview of prosthesis available for amputees
? Basics of evaluation of patients
? Prosthetic prescription


Postoperative and Preprosthetic Care

Individuals with New Amputation
? Likely to experience acute surgical pain
? Grieving the loss of his or her limb- requires significant psychological

adjustment.

Early Goals

? Healing of suture line and overall health

status.

? Enhancing early single limb mobility and self

-care

? Control of edema and pain management
? Optimal shaping of the residual limb for

prosthetic wear

? Assessment of the potential for prosthesis
Assessing Residual Limb Length and Volume

? Important determinants of readiness for prosthetic use, as well as

socket design

? Stump length needs to be documented

? Limb volume and shape of a transtibial residual limb is assessed

by taking successive circumferential measures

REHABILITATION

? Prosthesis

? Conventional- Cheaper to produce but are heavy.

? Endolite - composite carbon fiber is used.

? Has to be custom made and tailored to be useful to the patient.
? A large number of patients do not use their prosthesis if it is

cumbersome or heavy


Immediate postoperative prosthesis

The socket

? Interface between the residual limb and

the prosthesis

? All the forces from the ground during gait

are transferred to the limb

? Forces from the limb needed to control

the motion of the prosthesis are

transferred to the prosthesis


Extra component that is mounted directly

under the socket to reduce amount of torque

and shock

socket and pylon are concealed to within a

cosmetic cover.


Potential of Use

Level K 0
? No potential to ambulate or transfer safely with assistance .
Level K1
? Potential to use a prosthesis for ambulation on level surfaces at fixed

cadence.

? Limited and unlimited household ambulator.

K1- Solid-ankle, cushion-heel (SACH) foot

? Most basic prosthetic foot available.
? Immovable ankle and soft heel give

it the ability to absorb the impact of

heel strike

? Provides minimal energy return.
? For limited functional ability and

potential to ambulate.


Level K 2

? Potential for ambulation with the ability to traverse low-level

environmental barriers such as curbs, stairs or uneven surfaces.

? Typical of the limited community ambulator
? lightweight, have a flexible keel, a multiaxial ankle, and provide some

energy return

Level K 3

? Potential for ambulation with variable cadence.
? Ability to traverse most environmental barriers
? Have vocational, therapeutic, or exercise activity beyond simple

locomotion

? Hydraulic ankle/Microprocessor


Level K 4

? Potential for prosthetic ambulation

that exceeds basic ambulation skills,

exhibiting high impact, stress, or

energy levels.

? Typical of the child, active adult, or

athlete.

Selection of Foot- Importance?

? Ground reaction forces are transmitted
? Can be damaging to the person's residual limb, knee, hip, or back.
? Proper prosthesis - expand their capabilities and motivation

dramatically and allows them to improve range of activities

? At least design for one level above
A J- 20 years old

? A soldier, was when he endured traumatic injuries after driving

his motor vehicle over a landmine

? Below knee amputee
? Determined to run again and plans to enrol at a local college

Which foot does he require?

? K1
? K2
? K3
? K4


Answer ? K3 for daily use and K4 for running

Jaipur foot BK Prosthesis

? The shank is fabricated from locally

manufactured, durable, high-quality, high-

density polyethylene pipes (HDPE).

? The socket design used is either total

contact, which is vacuum-formed using a

polypropylene sheet, or open-ended, using

HDPE.

? This custom-made shank / socket is fitted

with the Jaipur Foot.


? Dorsi-flexion,
? Inversion / Eversion
? Transverse rotation
? Enables amputees to walk,

run, trek, swim, squat, sit cross

legged,

? walk on uneven terrain, work in

wet muddy fields

AMPUTATIONS OF THE HIP AND PELVIS

?Through the femur from

5cm distal to the lesser

trochanter .

?Disarticulations of the hip.

?Hindquarter amputations.
AMPUTATIONS OF THE UPPER LIMB

? Hand

? Preserve as much function as is possible.

? Salvage procedure

? Preserve length

? Mobility and sensibility

? Functions of pinch and grasp are very important.

AMPUTATIONS OF THE UPPER LIMB

? Wrist Disarticulations- Separate the carpal bones from the radius
? Forearm amputations- substance of the radius and ulna
? Elbow disarticulations- Humerus is preserved
? Arm amputations- 30% of humeral length
? Disarticulation of shoulder- less than 30% of humerus
? forequarter amputation- Shoulder and scapula
AMPUTATIONS OF THE UPPER LIMB

? Wrist amputations-preserve supination and pronation may be

transcarpal or disarticulation through wrist.

? Transcarpal ? Flexion and extension of radiocarpal joints should be

preserved

? Can be fitted with thin prosthetic wrist units.
? Long lever arm increases the ease and power to use the prosthesis.

FOREARM AMPUTATIONS

? Preserve as much length as possible.
? A smal stump is preferable to a through elbow
? Can be fitted with a good prosthesis.
DISARTICULATION ELBOW

? Broad flair can be firmly grasped by the prosthesis

socket

? Humeral rotation can be transmitted to the

prosthesis.

? Preferable to a more proximal amputation

ARM AMPUTATIONS

? Trans condylar after prosthetic fitting function as elbow

disarticulations

? Proximal level amputations require and inside elbow lock

mechanism and an elbow turntable

? Preserving the proximal humerus is valuable-cosmetical y the

contour of the shoulder is preserved and the grip of the socket is

better .


SHOULDER AMPUTATIONS

? Surgical neck
? Disarticulation of the shoulder
? Forequarter amputation
? With prosthesis function is so severely impaired that the prosthesis

can only be used as a holding device when performing activities

with both hands.

Conventional (body-powered)

transhumeral prosthesis



Terminal Devices
PROSTHETIC PRESCRIPTION

? socket design
? skin-socket interface
? suspension strategy
? Additional modular components

SUMMARY

? Prosthetic rehabilitation of persons with amputations is both

challenging and rewarding.

? Success is often difficult to measure purely in clinical terms
? Maximizing individual functional potential
? Appropriate amount of technology to assure acceptable outcomes

are highly predictive of success.

This post was last modified on 07 April 2022